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For an extended period, bouncing over the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself being sick. She was in labour, in extreme pain after her uterine wall split, but was now being tossed around in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this harsh landscape, are women. They reside in secluded encampments in the desert with limited water and food, few job opportunities and with treatment often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I continuously experienced infections during my gestation and I had to go the clinic seven times – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my uterine muscles failed,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the agony; it was so bad I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the current influx of refugees, but the conditions endured by the Sudanese place additional women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the medics are able to rescue numerous, but it is what occurs with the women who are fail to get to the hospital that alarms the professionals.

In the 24 months since the civil war in Sudan erupted, 86% of the displaced persons who came and settled in Chad are females and minors. In total, about one point two million Sudanese are being hosted in the eastern part of the country, 400,000 of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the millions of people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many males have not left to be in proximity to homes and land; many were killed, captured or forced into fighting. Those of employable age rapidly leave from Chad’s isolated encampments to look for jobs in the main city, N’Djamena, or beyond, in neighbouring Libya.

It implies women are abandoned, without the resources to provide for the young and old left in their care. To reduce density near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with average populations of about fifty thousand, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but not much more. There is no work, families must journey for extended periods to find firewood, and each person must get by with about minimal water of water a day – much less than the advised quantity.

This seclusion means hospitals are admitting women with complications in their pregnancy when it is almost too late. There is only a single ambulance to serve the area between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to wait an entire night for the ambulance to come.

Imagine being in the final trimester, in childbirth, and journeying for a long time on a animal-drawn transport to get to a hospital

As well as being uneven, the path goes through valleys that become inundated during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an emergency, with some women having to make long and difficult journeys to the hospital by walking or on a pack animal.

“Imagine being in the late stages of pregnancy, in labour, and travelling hours on a cart pulled by a donkey to get to a hospital. The biggest factor is the delay but having to arrive under such circumstances also has an influence on the delivery,” says the surgeon.

Malnutrition, which is on the rise, also elevates the likelihood of issues in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has stayed at the medical facility in the couple of months since her caesarean. Suffering from malnutrition, she got sick, while her son has been regularly checked. The male guardian has gone to other towns in look for employment, so Mohammed is totally dependent on her mother.

The nutritional care section has expanded to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in oppressive temperatures in almost total quiet as health workers work, mixing medications and assessing weights on a instrument created using a bucket and rope.

In moderate instances children get small bags of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a daily dose of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through a nasal drip. The baby has been ill for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see additional kids coming in in this tent,” she says. “The meals we consume is poor, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can find employment, but here we’re relying on what we’re provided.”

And what they are given is a small amount of cereal, edible oil and salt, handed out every couple of months. Such a simple food is deficient in nutrients, and the little cash she is given acquires minimal items in the weekly food markets, where values have increased.

Abubakar was relocated to Alacha after arriving from Sudan in 2023, having run from the militia Rapid Support Forces’ assault on her birthplace of El Geneina in June that year.

Unable to get employment in Chad, her partner has traveled to Libya in the desire to raising enough money for them to follow. She lives with his family members, dividing up whatever nourishment they obtain.

Abubakar says she has already witnessed food rations being cut and there are fears that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent